Reversal of steroid- and anti-lymphocyte antibody-resistant rejection using intravenous immunoglobulin (IVIG) in renal transplant recipients

Patrick P.W. Luke, Velma P. Scantlebury, Mark L. Jordan, Carlos A. Vivas, Thomas R. Hakala, Ashok Jain, Alka Somani, Sheila Fedorek, Parmjeet Randhawa, Ron Shapiro

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Abstract

Background. Despite the recent advances in immunosuppression, steroid-resistant rejection remains a difficult problem in renal transplant recipients. Methods. We reviewed our experience with i.v. immunoglobulin (IVIG) in the treatment of steroid- and antilymphocyte antibody-resistant rejection in renal transplant patients. Between September 1996 and March 1999, 17 patients were treated with IVIG to reverse steroid- or antilymphocyte antibody-resistant rejection. A total of 2 g/kg of MG was administered to patients during each treatment course. Results. With a mean follow-up of 21.5±9.5 months from the time of IVIG administration, patient and graft survival rates were 94% (16/17) and 71% (12/17), respectively. The baseline mean serum creatinine level prior to rejection was 2.2±0.7 mg/dl and peaked at 3.3±1.1 mg/dl at the time of the diagnosis of refractory rejection. IVIG therapy was associated with a fall in the mean creatinine to 2.8±1.1 mg/dl. The most recent serum creatinine in patients with functioning grafts was 2.8±1.6 mg/dl. In 82% of allograft biopsies after IVIG, reversal or reduction in the severity of rejection was demonstrated. In addition, IVIG therapy rescued three of four patients with antilymphocyte antibody-resistant rejection. Conclusions. IVIG rescue therapy for steroid- or antilymphocyte antibody-resistant rejection is associated with resolution or improvement of rejection severity, stable renal function, and reasonable graft survival.

Original languageEnglish (US)
Pages (from-to)419-422
Number of pages4
JournalTransplantation
Volume72
Issue number3
DOIs
StatePublished - Aug 15 2001

All Science Journal Classification (ASJC) codes

  • Transplantation

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    Luke, P. P. W., Scantlebury, V. P., Jordan, M. L., Vivas, C. A., Hakala, T. R., Jain, A., Somani, A., Fedorek, S., Randhawa, P., & Shapiro, R. (2001). Reversal of steroid- and anti-lymphocyte antibody-resistant rejection using intravenous immunoglobulin (IVIG) in renal transplant recipients. Transplantation, 72(3), 419-422. https://doi.org/10.1097/00007890-200108150-00010